Public Health Wales Research and Development 2016/17
Public Health Wales Research and Development 2016/17
The following table contains all research and development projects, which concluded in the 2016/17 financial year.
Public Health Wales# / Project Title / Lay Summary / Public Health Wales Investigator/Collaborator / Useful Links and Publications
PUBLIC HEALTH SERVICES
1 / FH02 Mammographic surveillance in women aged 35 to 39 years at enhanced familial risk of breast Cancer / Women with a family history of breast cancer are at increased risk of developing the disease themselves and this risk is particularly increased at younger ages. Only 1 in 200 people develop breast cancer before age 40, but women at high and moderate risk due to family history at this very young age have a risk between 1 in 10 and 1 in 60. The benefits of an annual mammography in terms of early diagnosis and potential lives saved needs to be balanced against the risks such as earlier radiation exposure and false positive tests that may lead to unnecessary surgery. This trial will inform the NHS as to whether mammographic surveillance will be cost effective in terms in the likelihood of saving lives and whether there is an adequate trade off between these benefits and the attendant risks. / Dr Rosemary Fox (Director of Screening Division)
/ Evans DG, Thomas S, Caunt J, Roberts L, Howell A, Wilson M, Fox R, Sibbering DM, Moss S, Wallis MG, Eccles DM; FH02 study group, Duffy S. 2014. Mammographic surveillance in women aged 35-39 at enhanced familial risk of breast cancer (FH02).Fam Cancer. 13(1):13-21. doi: 10.1007/s10689-013-9661-8.
2 / DURESS Study - Cryptosporidium in Upland Hosts and Vectors / The protozoan parasite Cryptosporidium represents a major health concern associated with surface waters. Outbreaks of gastrointestinal illness have been linked to upland supplies. Unlike most waterborne pathogens, Cryptosporidium is not controlled by chlorination. Kill or removal from water requires expensive treatment technologies mainly applied in high income countries. Further, there are increased risks of exposure for people served by small, often private, water supplies. Cryptosporidium causes an acute gastroenteritis (cryptosporidiosis), with between 3000 and 6000 laboratory confirmed cases reported each year in the UK. Two species, C. parvum and C. hominis, account for most cases. Not all species of Cryptosporidium are infectious to humans and some species are more adapted to some hosts than others. We know that farmed animals and sewage from septic tanks can be sources of contamination in upland rivers, but little is known about the possible role of aquatic animals in the transmission of Cryptosporidium as there is a limited amount of previous research in this topic area. It has been shown that some animals such as birds, flies and shellfish may act as transport vectors of human infectious Cryptosporidium species without becoming infected themselves. Birds can become infected but with different species. Nothing is known about whether other filter feeders, such as aquatic insect larvae, may also have a similar role in harbouring the parasite. We aim to find out whether insect larvae can harbour Cryptosporidium and to find out more about the role of insectivores, fish and birds in transmission of the parasite in upland catchments. / Professor Rachel Chalmers
(Head of Cryptosporidium Reference Unit)
/
3 / Protecting the health of Europeans by improving methods for the detection of pathogens in drinking water and water used in food preparation: AQUALVALENS / AQUAVALENS is an EU funded collaborative project centered on the concept of developing suitable platforms that harness the advances in new molecular techniques to permit the routine detection of waterborne pathogens and improve the provision of hygienically safe water for drinking and food production. It is vital for improving risk assessment and risk management of water supplies that robust techniques are developed that can inform better our knowledge of the occurrence and abundance of waterborne pathogens presenting a threat to individual water supplies. Our work will centre on the applied parasitology aspects of AQUAVALENS for the detection, virulence assessment and subtyping of major waterborne protozoa: Cryptosporidium and Giardia. / Professor Rachel Chalmers
(Head of Cryptosporidium Reference Unit)
/ Chalmers RM, Elwin K, Featherstone C, Robinson G, Crouch N, Davies AP. Clinical and microbiological investigation of zoonotic cryptosporidiosis in two children by routine diagnostic methods and quantitative polymerase chain reaction. Journal of Veterinary Medicine and Research 2016; 3(3): 1054.
Pérez-Cordón G, Robinson G, Nader J, Chalmers RM. Discovery of new variable number tandem repeat loci in multiple Cryptosporidium parvum genomes for the surveillance and investigation of outbreaks of cryptosporidiosis. Experimental Parasitology 169 (2016) 119e128
DOI:10.1016/j.exppara.2016.08.003
Moore CE, Elwin K, Phot N, Seng C, Mao S, Suy K, Kumar V, Nader J, Bousfield R, Perera S, Bailey JW, Beeching NJ, Day NPJ, Parry CM, Chalmers RM (2016) Molecular characterization of Cryptosporidium species and Giardia duodenalis from symptomatic Cambodian children. PLoS Neglected Tropical Diseases 10(7): e0004822.
Bouzid M, Elwin K, Nader J, Chalmers RM, Hunter PR, Tyler KM.2016. Novel real-time PCR assays for the specific detection of human infective Cryptosporidium species. Virulence, online journal DOI 10.1080/21505594.2016.1149670
Chalmers RM, Robinson G, Hotchkiss E, Alexander C, May S, Gilray J, Connelly L, Hadfield SJ. Suitability of loci for multiple-locus variable-number of tandem-repeats analysis of Cryptosporidium parvum for inter-laboratory surveillance and outbreak investigations. Parasitology 2016 Feb 2:1-11. DOI:10.1017/S0031182015001766
Hadfield SJ, Pachebat JA, Swain MT, Robinson G, Cameron SJS, Alexander JL, Hegarty MJ, Elwin K, Chalmers RM. Generation of whole genome sequences of new Cryptosporidium hominis and Cryptosporidium parvum isolates directly from stool samples. BMC Genomics 2015, 16:650 DOI:10.1186/s12864-015-1805-9
Presentation by Rachel Chalmers at British Society for Parasitology Autumn meetingCryptosporidium genotyping – where are we, where are we going and how will we get there? Date: 14/09/15, Royal Veterinary College, London
Presentation by Rachel Chalmers to the food industry Cryptosporidium, Date: 09/10/15, Campden BRI, Chipping Campden
Presentation by Rachel Chalmers to members of COST Action EURO-FBPHuman epidemiology and foodborne outbreaks, Date: 16/06/16, Robert Koch Institute, Berlin
Presentation by Guy Robinson and Gregorio Pérez-Cordón to Public Health Wales and stakeholdersIdentification of new VNTR in Cryptosporidium parvum genomes for the surveillance and investigation of outbreaks of cryptosporidiosis, Date: 04/07/16, Cardiff
Poster by Kristin Elwin at the health Related Water Microbiology conferenceDevelopment of molecular tools for the assessment of quantity and identity of Cryptosporidium species and Giardia duodenalis assemblages in water, Date: 09/2015, Lisbon
Presentation by Rachel Chalmers to the water industry Cryptosporidium DNA typing, Date: 25/03/15, London
Presentation by Guy Robinson to attendees of British Council courseCryptosporidium Reference Unit: National and International Services and Research, Date: 03/02/15, Sao Paulo
Presentation by Rachel Chalmers to Public Health WalesScience in Public Health: genomics, Date: 19/03/15, Cardiff
4 / Feasibility of reduction in right sided bowel cancer through CONtrast enhanced colonoscopy (CONSCOP) / Colorectal cancer is the second leading cause of cancer deaths in the UK. The Bowel Cancer Screening Programme (BCSP) was implemented to reduce deaths by the early prevention and detection of bowel cancer. Results from the first few years of screening and previous smaller studies show that while in its current form it will save many lives, there continue to be polyps and cancers in right side of the colon that may be difficult to detect. There is some evidence that these types of polyps (serrated polyps) may be at least partly responsible for cancers missed at the initial colonoscopy and have a faster rate of growth to cancer compared to conventional polyps (adenomas).
This feasibility trial aims to examine participants undergoing screening colonoscopy with the addition of a contrast dye (a safe food colouring agent base already used in various bowel camera procedures in standard clinical practice). This has been shown to improve detection of conventional polyps significantly. The study is a randomised controlled feasibility study comparing two groups, with and without use of dye spray throughout the right colon. Our primary aim is to study the feasibility of undertaking these procedures. In addition to this we will also be assessing as to whether this technique helps to improve the detection rates of rightsided polyps in order to inform the sample size for a larger study. Removal of these polyps will enable further laboratory analysis of a collection of polyp samples in order to assess if such a sample collection might be able to answer the question of biological behaviour and growth pattern to cancer in a larger subsequent study within the BCSP. / Ms Hayley Heard (Head of Programme, Bowel Screening) /
5 / A Pilot Study to Determine The Possible Effect Of Cryptosporidium Bowel Infection with regard to its relationship with
Secondary Pancreatic Dysfunction / The concise aim of this pilot study is to investigate, following initial evocation, the hypothesis that concurrent or historical infection with cryptosporidium, a common stomach bug in certain parts of the world, results in failure of the pancreas to produce the enzymes associated with digestion of food.
In order to fulfil our objective, we will seek to determine if the hypothesised link between cryptosporidium infection and failure of the pancreas to produce it's enzymes is just, by conducting a pilot study in conjunction with The National Cryptosporidium Reference Unit. A further more detailed research project is proposed if the results of the aforementioned prove to be fruitful.
The National Cryptosporidium Reference Unit located in Swansea is a centre of excellence and liaises with, and receives samples from, general practices and other hospitals throughout the country. This allows it access to a large number of infected stool samples.
Our primary modality of investigation will be to access the stool samples that are proven to be infected with cryptosporidium. We will then perform retrospective analysis on the samples, taking into account our inclusion and exclusion criteria, ensuring that the samples provide true and accurate results.
An initial cohort of twenty of these patients will have their stool samples analysed. / Professor Rachel Chalmers
(Head of Cryptosporidium Reference Unit)
6 / A participatory action research project to explore the health concerns of adult male prisoners in Wales and how
prisoners can be empowered to address these concerns, working towards improving their own health and that of their
families / This study will use participatory action research (PAR) to explore practical ways in which prisoners can be empowered to maximise their own health whilst they are in prison. The collaborative nature of PAR, where prisoners work alongside the research team, aims to empower prisoners to co-lead the research and develop the findings. The chiefinvestigator and other key investigators will firstly hold voluntary qualitative group and individual interviews with adult mainstream prisoners at HMP Parc to uncover their main health issues of concern. Following this, a team of between 10-15 prisoners will be recruited to work as researchers in the project, supported by staff from Public Health Wales and HMP/YOI Parc Prison. Together, this research team will be expected to further explore the main health issues of concern to prisoners at the prison and to work collaboratively to propose practical ways in which prisoners can be empowered to maximise their own health. The research group will report progress to the prison Directors quarterly and will work with them to explore implementation of the findings. On completion of the study a full report will be submitted to a peer-reviewed journal as well as internal reports for Public Health Wales and the National Offender Management Service (NOMS). Findings, in the form of an informal newsletter will be published for other prisoners at Parc prison. / Dr Stephanie Perrett
(Lead Nurse for Health and Justice)
7 / Preventing blood borne virus infection in people who inject drugs in the UK: the development and feasibility of psychosocial interventions (Phase 2) / In the UK, around 50% of people who inject drugs (PWID) have been infected with the Hepatitis C virus and around one in 100 has HIV. Approximately one in six have ever been infected with the Hepatitis B virus. PWID are at risk of these blood borne viruses (BBV) as a result of sharing injecting equipment (needles and syringes, water, spoons, cotton etc.) and unsafe sex. Preventing PWID from getting or passing on BBV is an important health issue. Opiate substitution therapy and needle exchanges have reduced BBV but behavioural interventions that teach people how to reduce risk behaviours could further prevent the spread of these BBV.
The project has 6 phases. In Phase 1, a review of the evidence on what type of intervention works for whom will be carried out. In Phase 2, the views of 60 PWID attending needle exchanges, homeless hostels, drug treatment and harm reduction centres in England (London, Yorkshire), Scotland (Glasgow) and North Wales will be sought on what type of psychosocial interventions they would find useful and acceptable. In Phase 3, the views of 40 UK (from England, Scotland, Northern Ireland and Wales) drug treatment NHS and third sector service providers and policy makers will be gathered using telephone interviews on the delivery and effectiveness of psychosocial interventions. Findings from Phases 1-3 will be used to develop a psychosocial intervention in Phase 4, the feasibility and acceptability of the psychosocial intervention will be assessed in 4 areas of the UK in Phase 5. In Phase 6, discussions with another 4-6 UK regions will take place to identify any challenges with conducting the research/ introducing the psychosocial intervention to their treatment settings in the future. Currently, ethical approval is sought for Phase 2. / Dr Noel Craine
(Research Scientist)
8 / Improving injecting skills and preventing blood borne virus infection in people who inject drugs in the UK: A feasibility
randomised control trial of a psychosocial intervention (Phase 5) / In the UK, around 50% of people who inject drugs (PWID) have been infected with the Hepatitis C virus and around one in 100 has HIV. Approximately one in six have ever been infected with the Hepatitis B virus. PWID are at risk of theseblood borne viruses (BBV) as a result of sharing injecting equipment (needles and syringes, water, spoons, cotton etc.) and unsafe sex. Preventing PWID from getting or passing on BBV is an important health issue. Opiate substitution therapy and needle exchanges have reduced BBV but behavioural interventions that teach people how to reduce risk behaviours could further prevent the spread of these BBV. The project has 6 phases. In Phase 1, a review of the evidence on what type of intervention works for whom will be carried out. In Phase 2, the views of 60 PWID attending needle exchanges, homeless hostels, drug treatment and harm reduction centres in England (London, Yorkshire), Scotland (Glasgow) and North Wales will be sought on what type of psychosocial interventions they would find useful and acceptable. In Phase 3, the views of 40 UK (from England, Scotland, Northern Ireland and Wales) drug treatment NHS and third sector service providers and policy makers will be gathered using telephone interviews on the delivery and effectiveness of psychosocial interventions. Findings from Phases 13
will be used to develop a psychosocial intervention in Phase 4, the feasibility and acceptability of the psychosocial intervention will be assessed in 4 areas of the UK in Phase 5. In Phase 6, discussions with another 46 UK regions will take place to identify any challenges with conducting the research/ introducing the psychosocial intervention to their treatment settings in the future. Currently, ethical approval is sought for Phase 5. / Dr Noel Craine
(Research Scientist)
/ Gail Gilchrist; Davina Swan; April Shaw; Ada Keding; Sarah Towers; Noel Craine; Alison Munro; Elizabeth Hughes; Steve Parrott; John Strang; Avril Taylor; Judith Watson.2017. The acceptability and feasibility of a brief psychosocial intervention to reduce blood borne virus risk behaviours among people who inject drugs: A randomised control feasibility trial of a psychosocial intervention (The PROTECT study) versus treatment as usual. Harm Reduction Journal. 14:14 DOI: 10.1186/s12954-017-0142-5
Link:
Gilchrist G, Swan D, Shaw A, Keding A, Towers S, Craine N, Munro A, Hughes E, Parrott S, Mdege N, Strang J, Taylor A, Watson J.2017. Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial.
Health Technol Assess.21(72):1-312. doi: 10.3310/hta21720.
HEALTH AND WELLBEING
9 / Welsh Study of Mothers and Babies: Prospective cohort study of renal disease in early childhood. / We propose to use routinely collected health data to explore whether babies with a marker in one or both kidney/s (enlargement of the tubes that collect urine in the kidney, called pelvicalyceal dilatation) detected during pregnancy have more urinary tract infections or hospital admissions for kidney problems during childhood, compared to babies without a marker. / Professor Shantini Paranjothy (Mansel Talbot Professor of Preventive Medicine, Cardiff University and Honorary Contract with Public Health Wales) / / Hurt, L.et al. 2016. Prevalence of defined ultrasound findings of unknown significance at the second trimester fetal anomaly scan and their association with adverse pregnancy outcomes: the Welsh Study of Mothers and Babies population-based cohort.Prenatal Diagnosis36(1), pp. 40-48. (10.1002/pd.4708)
Hurt, L.et al. 2014. The Welsh study of mothers and babies: protocol for a population-based cohort study to investigate the clinical significance of defined ultrasound findings of uncertain significance.BMC Pregnancy and Childbirth14,article number:164. (10.1186/1471-2393-14-164)
10 / A novel peer-support
intervention using Motivational Interviewing for breastfeeding maintenance: a UK feasibility study / Although 80% of mothers start breastfeeding in the UK, fewer than half breastfeed exclusively after one week and only 1 in 100 breastfeed exclusively to 6 months. Most women stop breastfeeding before they had planned. It is not known how breastfeeding peer-support (BFPS) should be provided in the UK for breastfeeding maintenance.
We will develop a new BFPS intervention that uses a motivational interviewing (MI) approach to help mothers who are young or live in disadvantaged areas to continue breastfeeding for longer. MI is a form of counselling that supports people in changing behaviour by exploring their thoughts and concerns and supporting them in setting their own goals.